The Intersection Between Anesthesia, Menopause, and Oral Health with Dr. Sandra Bargeron

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If we talk about postmenopause, right, estrogen drives our neuroprotective and even the volume of our brain is impacted by declining progesterone.
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We scan the brains of a postmenopausal woman who has never been on hormones, they are going to have, they have shown them to have smaller brains.
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The brain shrinks with declining estrogen.
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And so if it does that like on a volume size, you know it's doing that on a neuronal level, which means it's not going to handle the stress of surgery as well.
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Anything we bring into surgery creates stress, is going to cause more impact on the brain.
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Welcome back to the menopause disruptor podcast.
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We are going to talk about a really rare, never thought-of topic with menopause, and that is preparing for surgery.
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Let me pose this question.
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What if preparing for surgery meant more than fasting, arranging a ride home, and getting your paperwork in order?
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What if one of the most important things you could prepare for was your brain?
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We tend to think of anesthesia as simply being put to sleep.
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But anesthesia isn't sleep, it is a carefully controlled alteration of consciousness, and surgery itself places an enormous physiological demand on the body and the nervous system.
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And here's where today's conversation gets particularly interesting for women in midlife.
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Because the brain you bring into the operating room matters.
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Your sleep, your metabolic health, your medications, your stress load, your physical fitness, your previous neurological history, and potentially where you are in your hormonal journey.
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And for women navigating perimenopause and menopause, this raises some fascinating questions.
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Could fluctuating hormones influence how our brains respond to anesthesia?
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And why do some women wake up feeling relatively clear while others experience prolonged brain fog, nausea, fatigue, or cognitive changes?
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And what happens when we add a history of concussion, chronic sleep disruption, neurodivergence, or other neurological vulnerabilities to the equation?
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My guest today has spent more than two decades at the head of the operating table, Sandra Bergeron.
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She is a certified anesthesiologist assistant with more than 22 years in medicine and more than 10,000 anesthesia cases under her belt.
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And after years of watching patients respond very differently to what might appear to be the same surgical experience, she began asking a bigger question.
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How much neurological resilience does a person actually have before they go into surgery?
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That question became the foundation of her work at Beyond Brain Health.
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Her neurological stress and recovery index, NSRI, and her book, Breakthrough Anesthesia Fog, Protect Your Brain and Heal Faster After Surgery.
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Sandra's approach challenges us to think differently about surgical readiness.
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Not just am I medically cleared, but how prepared is my brain and my nervous system for this stress?
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And I particularly wanted to have this conversation because we recently explored on this podcast what happens when concussion collides with menopause.
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And today we're addressing another piece to that puzzle, anesthesia and surgical stress.
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So whether you have a surgery coming up, have experienced that frustrating post-surgical brain fog, or you're simply interested in understanding how we can build greater neurological resilience as we move through midlife, I think that you're going to find this conversation absolutely fascinating, mind-blowing, pun intended.
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Please join me in welcoming Sandra Bergeron to the Menopause Disruptor Podcast.
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Welcome, Dr.
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Bergeron.
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I'm so happy to have you here because we are going to talk about one of my primary focuses for many reasons, and that is brain health, but very new ones.
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First of all, so glad to have you here.
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Well, thanks for having me.
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I can definitely talk on this topic a lot.
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I have a lot of passion behind it.
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So I'm happy to be here.
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Okay.
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So do you like to go by Dr.
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Bergeron?
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I like to go by Sandra.
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It's confusing because I have a PhD and I don't want any medical doctor to think I'm calling myself a medical doctor because I'm not a medical doctor.
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I am a double-boarded practitioner.
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I have two separate degrees.
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Um a physician assistant, general practice physician assistant, got that degree in 2004.
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I graduated in 2004.
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So I practiced in the OR primarily.
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I was a first assistant in the OR, so I scrubbed in and operated on all kinds of things.
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I also did a little bit of emergency room, moonlighting, and then outpatient care and type things like that.
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I didn't love medicine.
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So I actually was going to go to medical school.
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But my father-in-law was a retiree, he was retiring from orthopedic surgery, and he said, the direction medicine is going, you're really not gonna like it.
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Just go be a PA and then you can have better life work-life balance.
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And you know, it's not the marathon of the degree.
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He may have been right in the sense that, like when it comes to research, I'm definitely a high-level thinker.
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So I don't know, maybe it would have been good to go to medical school just to have that as a something to piggyback on for research.
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As it is, I do research without the degree, but I learned it was a good thing.
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I learned early that oh boy, I don't like this.
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I don't like so I'm glad I didn't go, right?
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I don't like band-aiding medication, like people with medications or like the two options were operate or give a medication.
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The medication always had a side effect, which led to more medications.
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I'm like, this is is this really what we do in medicine?
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So it was like it wasn't very long into my career that I had this like existential crisis, and I was like, what am I supposed to do with this?
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I don't like this.
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I really didn't like it.
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And because I was in the operating room, I was introduced to the profession of anesthesia in a non-medical doctor realm, which because yes, I could have gone back to medical school and all that, but again, I had this like, I don't really like this the way we do medicine.
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So, like, what what can I do that will give me the opportunity to practice the art of medicine, to use medications in a way that are limited and providing like good relief for human suffering.
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Anesthesia makes sense, right?
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You put people to sleep with a medication, they don't go home on it.
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It's a compassionate and uh safety-oriented job, and it takes a lot of brain power and it's critical thinking and all the things that I'd like to do.
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So I went back and got my anesthesia degree, which is two separate degrees.
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So two two two and a half year degrees basically, five years combined.
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Wow.
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And so I graduated in 2010 and I took two boards.
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I took my PA boards and my anesthesia boards and started practicing.
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So I've been practicing anesthesia since 2010, medicine since 2004, and I've seen this gamut because I was as a PA, I was writing prescriptions and assisting.
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I've seen the perspective from all aspects of surgery and anesthesia and medicine, even in the urgent emergency care kind of realm.
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So I really got a good view of the system in medicine, the things I don't like about it, the what areas we could strengthen it, some things that are good about it.
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But, you know, I have a good view of that.
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It wasn't until after anesthesia school that my own health journey, my son's health journey all led to further education, which led to my PhD.
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And that is where I got functional medicine training, and that's where we are now.
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That's how we landed in the space where I'm doing brain health from like protecting the brain around anesthesia and offering solutions in that realm because it wasn't without that education, there wasn't a real direction to do that that thing.
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So that's my background.
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That's incredible.
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Wow, and what a nuanced, unique niche area of brain health, anesthesia.
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A real fun time talking about anesthesia.
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And and it's not an easy word to say, it's very Latin.
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And today I just seem to be tongue-tied.
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But so, and the menopause and anesthesia connection.
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I mean, that is something we just don't hear about.
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But it's very important.
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And you started noticing that in the operating room that made you realize that we weren't paying enough attention to what actually happens to the brain during and after anesthesia.
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Anesthesia.
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Anesthesia.
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Let's talk about that.
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Well, let's let me give you a little background.
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So, my my mother-in-law, two family members in my career or my life impacted the trajectory of how I viewed this because in medicine, especially in anesthesia, we do learn about cognitive decline risks with anesthesia in our training.
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But anesthesia is a critical care specialty.
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What that means is our primary priority is that you manage to get through surgery safely.
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You don't have a heart attack, you don't have a stroke, you don't die.
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Okay.
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That is our number one priority that you are safe through surgery.
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And surgery is a situation where we put you in a position where it's life-threatening, like you're being operating around.
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It's a very stressful event to the body.
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So it's not like sitting on cruise control.
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There's a reason we focus on those areas.
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That said, when we learn about cognitive decline in medicine, and this is true for it doesn't matter if you're a CRNA, an AA, or an anesthesiologist, you learn about the link to certain populations are at more risk for cognitive decline.
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And what our perspective in medicine is, well, what can we do medically to change that outcome right now, right?
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Anesthesia's critical care.
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So there's no pre, there's no post, you're not going to see your anesthesiologist in this wide spectrum of two a month before, two months after.
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You get them now.
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So what can we do right now?
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So we make decisions about spinals versus general.
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Do we maybe limit these drugs or you know, and we might make those decisions.
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We kind of talk about that.
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That's a lot in the literature of what we talk about in medicine, but it's not really designed to follow up with you and ideally optimize you.
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Like the profession isn't designed like that.
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Okay.
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Now, my mother-in-law, when she was in her 40s, she had the classic picture that I think so many people resonate with.
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And I promise this to tie it all again.
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She was in her mid 40s, late 40s, got diagnosed with chronic fatigue syndrome, and it was really profound.
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Anybody else relate to that in perimenopause?
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Like, I mean, right?
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It's like, oh, I'm in perimenopause now.
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I know because I ain't got no energy.
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So no memories.
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Memory, yeah.
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And just can't.
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Some days you're just like, I don't, I can't function.
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So of course she went through that.
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And when I met her and married her son, you know, she was a decade beyond that, but she still had like brain fog, memory, you know, just little, she called herself brain barts.
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You know, I just literally brain marts, it's okay.
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And then around 68, she had to have sudden open heart surgery.
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And unfortunately, that is one of the highest risk surgery for cognitive decline postoperatively, which I didn't know at the time I was a PA.
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I didn't know.
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I just knew that's a very dangerous surgery, and we want to make sure that everything is she makes it through safely.
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She doesn't die, you know.
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But afterwards, we saw a rapid change in personality, a big change in her memory, just major changes that were major, but they weren't dementia.
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They were just major to those who knew her.
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Do you know what I mean?
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Like her personality and all these things.
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So it followed her for another, you know, decade and she died of dementia.
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I mean, it's just a rapid decline.
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Oh my goodness.
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My goodness.
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So, in the midst of all that, my son developed Lyme disease.
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So, in the midst of her decline, I'm watching this, I'm trying to help her.
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I don't really know what to do.
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But my son gets sick with Lyme disease, and that kind of propelled me into functional medicine because there wasn't what are we going to do for Lyme disease, except antibiotics.
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And I wasn't willing to do that.
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I'd had enough understanding by that point to go, okay, I need real help with this.
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Like I couldn't find good help, like, I couldn't find a practice that really took the whole person into perspective.
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So that's what threw me into functional medicine and learning it for myself and figuring it out.
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And so that's when I started to look at her decline, the literature in medicine that we talked about.
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I we talk about it in our degree, right?
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I started to look at it with different eyes.
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I'm like, okay, but so wait, anesthesia is a stressful event.
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Surgery is a stressor.
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It's a toxic event, it's an inflammatory event, it's an immune stressor, it causes all these disruptions of the human body.
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Why don't we prepare for it?
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Or why don't we have some kind of plan to recover afterwards?
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Like, who's doing that?
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Nobody was doing that.
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Now, the interesting thing was is the literature was starting to pick up on like, here's the factor that we identify as consistently the factor that matters the most.
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And so in the anesthesia literature, what started to emerge was this pattern of it's not the drug.
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Like we looked at propofol, we looked at gas, we looked at general anesthesia, we looked at regional anesthesia.
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We look all the things that people ask me on my on my page, they're like, Well, what should I get a spinal?
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Should I, you know, like, is it worse with this drug?
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Is it worth we looked at that, we have been looking at that for 30 years.
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But what was emerging was it's the patient, it's the patient's resilience and their cognitive baseline.
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So even the medical literature was starting to say cognitive, like your cognitive baseline is more of a predictor of your outcomes than any of the drugs or even the surgery that you go through.
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So the difference between what the way I look at it and the way medicine looks at it is they look at it as a predictive model.
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So you can go get a cognitive test at your doctor's office.
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If you're in primary care, go see them, and they can refer you to a neuropsychologist or somebody, and they'll give you a cognitive assessment.
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Cognitive assessment is a measure of function and where you are now.
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Okay, you know, and it says, okay, well, because you're here, you're likely to have an outcome that's not so good.
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Okay.
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It doesn't tell us how to change anything.
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Cognitive is function is function.
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Resilience, and this will piggyback, I promise, into what you asked me about with the hormones.
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Resilience is a different animal.
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Resilience is how much capacity do you have to manage stress and how can we modify it?
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So when I started looking at this, you know, I started writing my book, I started realizing this was the problem.
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The literature is pointing to this.
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I was like, we need a measurement of resilience.
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Now, some groups were starting to look at those, and there was enough literature to pull from that.
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I had about like 130 different peer-reviewed studies to build what is now the NSRI, the neurologic stress and recovery index.
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And it looks at five separate domains that determine your neurologic resilience.
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One of them is hormones, so it's metabolic health.
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Hormones fall into that.
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Yeah.
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And so from there, we can look at, okay, these are the factors, these are the areas you're weak in, and those determine your neurological neurologic resilience.
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So maybe you're only weak in metabolic health and medication burden.
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Okay, those are two areas.
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Well, we can talk to your doctor, we can address this medication burden as a concern before surgery.
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And what about metabolic health?
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Can we do something with metabolic health?
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Can we get you moving?
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Can we get you on some biodentical hormones?
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What do we need to do here to improve your metabolic health so that you have more resilience going into surgery?
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Okay.
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That's the question that we built.
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That was a lot of information, but there you go.
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That's incredible.
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So just building metabolic health.
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And if someone whose resilience is indicator is quite low, they have a low baseline.
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Uh, how do you and you've got a set date for surgery?
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How do you get prepared in a fixed amount of time?
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And that could be very short.
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Sometimes you're on waiting list and all of a sudden they say, Okay, it's go time.
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How do you prepare?
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And is just a little bit of effort enough to say they're resilient, they have a better outcome from the surgery in the a little bit of effort is still worth a million pounds.
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So your question, I'll answer it directly, and then I want to give a little bit of context.
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Um, what do we do?
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So the reason the neurologic resilience, neurologic stress and recovery index is built around five domains is because if you have a short period of time to optimize, we need to know which domain is the weakest, right?
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We could throw a spaghetti at the wall and kind of try to optimize everything, but do you know what you're optimizing?
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I mean, are you getting sunlight?
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Okay, great.
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Are you eating nutritiously?
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What does that mean?
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Like, are we deficient?
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Are we on meds that are depleting things?
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I don't, you know, so the the tool actually gives a little bit of a structure to identify where to put your effort into in the in the four to five weeks you might have before surgery.
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You know, maybe maybe you just need to get outside and walk every day.
00:17:43.740 --> 00:17:48.139
Maybe you haven't been moving, and that little bit does build BDNF, right?
00:17:48.139 --> 00:17:54.779
So moving is a huge uh brain-drive neurotrophic factor stimulator.
00:17:54.779 --> 00:18:04.459
You can't actually supplement and you there are no supplements that quantify and build BDNF as much as movement does, right?
00:18:04.459 --> 00:18:05.579
So, right.
00:18:05.579 --> 00:18:12.619
So if we identify that's a vulnerability and you have a very sedentary lifestyle and you have six weeks to prepare, well, you're gonna prioritize.
00:18:12.619 --> 00:18:14.459
I want you to prioritize your movement.
00:18:14.459 --> 00:18:16.699
Get out there and walk outside.
00:18:16.699 --> 00:18:24.619
I don't care if it's 10 minutes, you're making a difference on neurologic health because it's it's a it's validated in the research.
00:18:24.619 --> 00:18:27.099
Um, can we improve sleep quality?
00:18:27.099 --> 00:18:36.779
Is there is are you inadvertently uh, you know, changing staying up too late, leave leaving blue lights on, screen time before bed?
00:18:36.779 --> 00:18:38.539
Are you doing that and not even noticing?
00:18:38.539 --> 00:18:41.179
And then you're completely disrupted all through the night.
00:18:41.179 --> 00:18:45.179
Well, that's where we consolidate all of our day, where we detox everything.
00:18:45.179 --> 00:19:00.059
And so if your body's coming into surgery with a whole lot of metabolic neurologic trash, well, then you're gonna have a harder time moving the increased burden of you know, neurotoxins out of the brain after surgery.
00:19:00.059 --> 00:19:05.259
So we can identify if sleep is something we need to focus on and we kind of get directions in that way.
00:19:05.259 --> 00:19:09.099
So that that's the concept behind the neurologic resilience.
00:19:09.099 --> 00:19:18.939
And I want to just kind of give a little context about why I built it out and brought it to the public because there are, I would be remiss to say that they aren't studying this kind of stuff.
00:19:18.939 --> 00:19:23.259
In fact, they were studying this 30 years ago.
00:19:23.259 --> 00:19:30.539
In 1999, this is before 2000, there was actually a study done by Yale.
00:19:30.539 --> 00:19:38.859
And it didn't even look at pre-operative optimization, it just looked at post-operative inpatient modifications to things.
00:19:38.859 --> 00:19:40.779
And that's part of what I teach in the book.
00:19:40.779 --> 00:19:44.939
Like, here's what we need to do before, here's what you do during, here's what you do after.
00:19:44.939 --> 00:19:48.219
Like the whole framework is in my book between all of that.
00:19:48.219 --> 00:19:52.379
But the cool thing was that they like they just did post-operative.
00:19:52.379 --> 00:19:58.139
All they did was like, hey, get them in front of the sun, don't interrupt their sleep, give them their hearing aids, make sure they had their glasses.
00:19:58.139 --> 00:20:02.379
Just simple, simple modifications, but very intentional.
00:20:02.379 --> 00:20:09.339
And they did that, and they actually reduced delirium by 40% just by doing those things inpatient.
00:20:09.339 --> 00:20:20.059
Then the hospitals that adopted that they saved accumulative like $7.3 million back in the 90s in cost to the hospital because they implemented such simple things.
00:20:20.059 --> 00:20:33.339
Now they did it as a trial, and the problem was is that the system, remember, I said I didn't like the system, medical system, the system is limited in being able to implement it.
00:20:33.339 --> 00:20:36.859
The hospital benefits from this, but insurance companies don't.
00:20:36.859 --> 00:20:40.939
There's no coding, there's nobody to own the job of managing this.
00:20:40.939 --> 00:20:43.819
Anesthesia's not, they're not a long-term follow-up.
00:20:43.819 --> 00:20:48.219
Hospitalists, well, hospitalists are generalists, they're not trained to do this.
00:20:48.219 --> 00:20:50.299
So are you gonna apply this to a hospitalist?
00:20:50.299 --> 00:20:51.579
You have to create a whole arm.
00:20:51.579 --> 00:20:54.219
Then can they even bill for this kind of service?
00:20:54.219 --> 00:20:54.699
No.
00:20:54.699 --> 00:21:04.379
So there are all these system failures for this to be able to become something that is nationwide, even though they proved that it worked and it reduced delirium by 40%.
00:21:05.500 --> 00:21:06.059
Significant.
00:21:06.299 --> 00:21:08.219
So, and that's 30 years ago, right?
00:21:08.219 --> 00:21:25.179
So the reality is that we know that these are things you can do, but we have no way inside the hospital system inside the medical system to like create a way for us to consistently offer it to patients and be the ones in medicine to drive it forward.
00:21:25.179 --> 00:21:30.859
So, though we are studying it, how do we make a difference for the patient right now?
00:21:30.859 --> 00:21:35.740
So, my approach was to go, look, it's been 30 years and they still haven't figured it out.
00:21:35.740 --> 00:21:38.859
So let's go and just bring this to the public.
00:21:38.859 --> 00:21:45.979
And this is why my whole page is about that, is and why I wrote the book and why I created the NSRIs like, hey, I'm gonna bring it to you.
00:21:45.979 --> 00:21:52.459
And you, the one with the skin in the game, the one that's gonna deal with the cognitive decline for the next decade.
00:21:52.459 --> 00:21:59.979
Yeah, you get to have the power to do the things that are modifiable and can improve your cognitive recovery, like huge.
00:21:59.979 --> 00:22:02.219
So that's the context I wanted to give.
00:22:02.619 --> 00:22:04.459
It's shocking, it's eye opening.
00:22:04.459 --> 00:22:08.619
Again, it's something that we would never think about in the context.
00:22:08.619 --> 00:22:24.699
Context of managing menopause and what happens to our brain when we're in surgery, particularly the brain that has outside of being a sedate lifestyle, but just the role that estrogen plays as a neuroprotector in our brain health alone.
00:22:24.699 --> 00:22:35.339
If we were to take a relatively fit woman who's been managing her all her lifestyle markers, you know, her nutrition is fairly strong or decent.
00:22:35.339 --> 00:22:36.939
Exercise, you know, it's there.
00:22:36.939 --> 00:22:39.500
Maybe she does a little bit of resistance training.
00:22:39.500 --> 00:22:42.539
And sleep is pretty well managed.
00:22:42.539 --> 00:22:43.979
Stressors, okay.
00:22:43.979 --> 00:22:46.859
Menopause in itself is a stressor on the border.
00:22:46.859 --> 00:22:48.539
Rising cortisol.
00:22:48.539 --> 00:22:53.899
So just that factor alone, rising cortisol or declining estrogen.
00:22:53.899 --> 00:22:58.939
How much does that put a menopausal woman at risk if she does have to go in for surgery?
00:22:58.939 --> 00:23:03.899
Maybe even it's just simple day surgery, but she's still going under anesthetic.
00:23:04.059 --> 00:23:04.379
Yes.
00:23:04.379 --> 00:23:11.500
I consider I consider that population a understudied, underrecognized population.
00:23:11.500 --> 00:23:16.779
I know everybody on this podcast probably shocked that women aren't getting studied properly.
00:23:16.779 --> 00:23:19.740
Hello, that's the story of medical research, right?
00:23:19.740 --> 00:23:24.939
But the reality, so I can't quantify, I can't give you a statistic because we aren't well studied in that area.
00:23:24.939 --> 00:23:29.099
But I can tell you this everything you mentioned is accurate.
00:23:29.099 --> 00:23:31.500
Like there's a rise in cortisol.
00:23:31.500 --> 00:23:34.779
And there's a difference between perimenopause and postmenopause, right?
00:23:34.779 --> 00:23:39.579
Because in perimenopause, we have these wild swings of our estrogen, up, down, up, down.
00:23:39.579 --> 00:23:43.979
We're excess estrogen one day, we're a lipoestrogenemic the next day.
00:23:43.979 --> 00:23:46.459
We're boom, boom, boom, boom as we drift our way down.
00:23:46.459 --> 00:23:51.339
Overall, we're low, but we still have these wild swings, which makes us feel crazy, right?
00:23:51.339 --> 00:23:52.699
Terrible.
00:23:52.699 --> 00:24:11.979
But those shifts have impacts on everything: your microbiome, your gallbladder, and the bile that you produce, and your all those things determine how well you detox from anesthesia, like how much you clear those anesthetic drugs, how much you manage the physiologic burden, how well you manage the inflammatory response.
00:24:11.979 --> 00:24:14.539
So, like, and we're just talking about estrogen.
00:24:14.539 --> 00:24:16.139
We haven't even talked about progesterone.
00:24:16.139 --> 00:24:26.939
Like progesterone alone is a key to driving cellular detoxification, being able to put yourself into rest and digest mode after a stressful response.
00:24:26.939 --> 00:24:47.419
So, as we have not just declining and swinging estrogens, we have declining progesterone, which means that less of a stressful the same stressor at 30 creates a profound stress response at 40 because of our progesterone declining and our likelihood to swing into fight or flight being higher, right?
00:24:47.419 --> 00:24:53.339
We don't calibrate as well because progesterone has declined and it drives parasympathetic response.
00:24:53.339 --> 00:24:56.059
So we have a lot of factors involved there.
00:24:56.059 --> 00:25:07.099
On top of that, now if we talk about postmenopause, right, estrogen drives our neuroprotective and even the volume of our brain is impacted by declining progesterone.
00:25:07.099 --> 00:25:14.539
We scan the brains of a postmenopausal woman who has never been on hormones, they are going to have, they have shown them to have smaller brains.
00:25:14.539 --> 00:25:17.579
The brain shrinks with declining estrogen.
00:25:17.579 --> 00:25:26.859
And so that if it does that like on a volume size, you know it's doing that on a neuronal level, which means it's not going to handle the stress of surgery as well.
00:25:26.859 --> 00:25:27.500
Does that make sense?
00:25:27.500 --> 00:25:33.339
Anything we bring into surgery creates stress, is going to cause more impact on the brain.
00:25:33.339 --> 00:25:38.219
So huge and but you don't detox as well, you don't stress response doesn't recover as well.
00:25:38.219 --> 00:25:44.219
You see the cortisol goes up, but also the parasympathetic response doesn't swing back to back baseline as easily.
00:25:44.219 --> 00:25:48.059
Your microbiome, your methylation, right?
00:25:48.059 --> 00:25:50.539
It's a big conversation right now about methylation.
00:25:50.539 --> 00:25:59.740
Well, why is it that it's so common after maybe let's just say 36, 40 for women to start experiencing the symptoms of their methylation dysfunction, right?
00:25:59.740 --> 00:26:06.539
They had the genetic propensity, they didn't really notice early on, but they really notice it.
00:26:06.539 --> 00:26:10.779
And they're going to the doctor and they're getting tested and they're finding out they have MTHFR.
00:26:10.779 --> 00:26:12.859
Well, they have it the whole time.
00:26:12.859 --> 00:26:18.139
It's just that the hormones impact the expression of your genes.
00:26:18.139 --> 00:26:25.339
So while estrogen and progesterone protect the expression of methylation, you know, maybe you have a genetic mutation.
00:26:25.339 --> 00:26:29.179
Even there, you can kind of make up for if you have healthy hormones.
00:26:29.179 --> 00:26:41.419
I'm really simplifying the signs here, but but you know, but once that protective activation of those methylation genes is declining, now you have MTFHFR expression.
00:26:41.419 --> 00:26:42.699
Do you know what I mean?
00:26:42.699 --> 00:26:45.419
So you don't you don't absorb your B vitamins as well.
00:26:45.419 --> 00:26:47.179
And on now you're becoming nutritional deficient.
00:26:47.179 --> 00:26:48.379
Now you get brain fog.
00:26:48.379 --> 00:26:50.299
Now you get, does that make sense?
00:26:50.619 --> 00:26:50.859
Yeah.
00:26:50.859 --> 00:26:53.659
Well, let's just take it back one more step for the lay person.
00:26:53.659 --> 00:26:56.379
And not all listeners are going to understand methylation.
00:26:56.379 --> 00:27:00.379
Let's just bring it back to the bare bones, methylation, its role in the body.
00:27:00.379 --> 00:27:03.019
And yeah, let's just go right into that.
00:27:03.259 --> 00:27:04.379
Yeah, methylation.
00:27:04.379 --> 00:27:15.899
So methylation is uh it's an intracellular, well, it's a cellular process by which we manage certain cellular processes and and basically absorb certain nutrients.
00:27:15.899 --> 00:27:18.459
So I'll just keep it super simple.
00:27:18.459 --> 00:27:23.740
The big thing is it is involved in the metabolism of your B vitamins.
00:27:23.740 --> 00:27:26.939
So your B12, your folate, and things like that.
00:27:26.939 --> 00:27:32.699
And so when you don't methylate well, you don't absorb the certain types of B vitamins very well.
00:27:32.699 --> 00:27:36.859
You really need methylated B vitamins in order to be able to absorb them.
00:27:36.859 --> 00:27:46.299
So your cyanocobamelin, which is your non-methylated B12, it will actually become toxic in the body if you don't methylate well.
00:27:46.299 --> 00:27:53.740
And so a lot of times people take supplements and they don't know which type of methylated, what type of B vitamin, what kind of vitamin they're taking.
00:27:53.740 --> 00:28:01.659
It's very often the cheaper cyanocobamelin, which is actually causing more problems for people who have methylation problems.
00:28:01.659 --> 00:28:06.139
And here's the thing 66.7% of the population has methylation dysfunction.
00:28:06.139 --> 00:28:07.339
So is that right?
00:28:07.339 --> 00:28:08.299
Two thirds.
00:28:08.299 --> 00:28:08.779
Yeah.
00:28:08.779 --> 00:28:16.379
So, and we're not talking about two alleles, we're talking about at least one gene, one from your parent is off.
00:28:16.379 --> 00:28:18.219
And so you're undermethylating.
00:28:18.219 --> 00:28:26.619
But methylation is really important because if you undermethylate, it also impacts cellular inflammation and atherosclerosis.
00:28:26.619 --> 00:28:33.019
So you can develop coronary artery disease more like you're more likely to develop that if you have undermethylation.
00:28:33.019 --> 00:28:34.859
So it impacts a lot of things.
00:28:34.859 --> 00:28:39.500
Poor methylation early in life can influence your fertility.
00:28:39.500 --> 00:28:44.379
So if you have poor methylation early in life, you might struggle with infertility.
00:28:44.379 --> 00:28:47.259
It's linked to some things like PCOS and certainly.
00:28:48.379 --> 00:28:49.099
Yeah, of course.
00:28:49.339 --> 00:28:54.779
And then certainly in the postmenopausal person, it becomes a lot more of an expression.
00:28:54.779 --> 00:28:59.500
We lose our resilience on every level as estrogen declines.
00:28:59.500 --> 00:29:01.659
So that's a DNA level.
00:29:01.659 --> 00:29:05.099
You know, we're talking about DNA there when we're talking about methylation.
00:29:05.099 --> 00:29:09.099
We lose our resilience in our brain, we lose our cardiovascular resilience.
00:29:09.099 --> 00:29:24.379
You'll see your HRV changes, like you know, hormones impact all systems that impact your overall resilience, which is why it's so important to talk about and why it influences anesthesia.
00:29:24.379 --> 00:29:28.059
So I now a little bit into the scientific explanation there.
00:29:28.059 --> 00:29:33.899
But the science is all we have is mechanistic or explanations on a mechanical level.
00:29:33.899 --> 00:29:39.019
Like we can explain the physiology because we don't haven't studied women properly.
00:29:39.019 --> 00:29:48.619
But what the point of it is, is that women and perimenopause are often overlooked in their recovery period because they're like, well, they're young and healthy.
00:29:48.619 --> 00:29:49.259
They're 40.
00:29:49.259 --> 00:29:53.339
When I see a 40-year-old in my OR table, I'm like, well, it's young and healthy.
00:29:53.339 --> 00:29:55.819
Thank God she's not 80, you know.
00:29:55.819 --> 00:30:01.099
But post-operatively, they're going to be resilient and they're not going to have a huge swing in their blood pressure.
00:30:01.099 --> 00:30:04.619
They're going to tolerate the anesthetic really well, is what we care about.
00:30:04.619 --> 00:30:13.659
But post-operatively, the ability to bounce back after surgery is certainly dropped drastically in that period of time.
00:30:13.659 --> 00:30:24.699
And for a woman who's in perimenopause and menopause, that 40-year-old woman, the thing about us is that we're dealing with our children and often aging parents.
00:30:24.699 --> 00:30:26.859
We're kind of the sandwich community, right?
00:30:26.859 --> 00:30:29.899
And we're working and we're trying to be a good spouse.
00:30:29.899 --> 00:30:42.139
And so when we experience the symptoms, they're not dementia, but they're post-operative cognitive dysfunction, which is what the name that the American Society of Anesthesiologists gives this.
00:30:42.139 --> 00:30:52.859
When there's this transient change in cognitive function, emotional health and stability, these types of things, that's got a name, the diagnosed, like an actual name.
00:30:52.859 --> 00:31:01.579
And when we experience it in our 40s while we're trying to do everything for everyone, those small changes make a big difference.
00:31:01.899 --> 00:31:12.939
Just like you were saying with your mother-in-law, just did not feel herself or an act herself to those who knew her more up close and personally that something had shifted.
00:31:13.259 --> 00:31:14.139
Huge change.
00:31:14.139 --> 00:31:15.339
Personality.
00:31:15.339 --> 00:31:17.419
Personality was huge change.
00:31:17.419 --> 00:31:20.299
And that makes relationships harder.
00:31:20.299 --> 00:31:21.899
It strains relationships.
00:31:21.899 --> 00:31:25.500
It makes it harder to just keep your job.
00:31:25.500 --> 00:31:26.779
You know what I mean?
00:31:26.779 --> 00:31:29.259
Like it's significant.
00:31:29.259 --> 00:31:31.579
So it's an underlooked thing.
00:31:31.579 --> 00:31:37.979
So, you know, though we're not looking, we're not saying, hey, you know, the 40-year-old woman's gonna have dementia after surgery.
00:31:37.979 --> 00:31:39.019
We're not saying that.
00:31:39.019 --> 00:31:40.939
But her cognition is impacted.
00:31:40.939 --> 00:31:47.179
And the problem is if she mentions that she's not feeling right, who's listening to that?
00:31:47.179 --> 00:31:53.339
Is there anybody listening and validating her and saying that makes sense?
00:31:53.339 --> 00:31:58.779
Or is she going to her doctor and hearing, well, I don't know, you should be fine by now.
00:31:58.779 --> 00:32:00.139
Surgery went fine.
00:32:00.139 --> 00:32:03.019
I would say be, like most of the time.
00:32:03.019 --> 00:32:05.819
And it's a form of inadvertent gaslighting.
00:32:05.819 --> 00:32:12.779
It's not that the the practitioners over here, you know, they know and they're just pretending they don't, you know, they don't know.
00:32:12.779 --> 00:32:20.539
They don't realize that this is a significant challenge for a 40-year-old to 50-year-old and beyond woman.
00:32:20.539 --> 00:32:23.179
And they don't really have anything to offer.
00:32:23.179 --> 00:32:25.659
So even if they did know, what would they do?
00:32:25.659 --> 00:32:27.019
That's the next question.
00:32:27.019 --> 00:32:27.979
You know what I mean?
00:32:27.979 --> 00:32:38.619
So they the problem is this population gets overlooked a lot and almost gasped inadvertently, like I said, you know, and left going, well, I don't know.
00:32:38.619 --> 00:32:41.339
I guess just got grit my teeth and get through this, right?
00:32:41.339 --> 00:32:51.899
And meanwhile, their relationships are struggling and they're struggling at work, and maybe they're a business owner, you know, and they can't even keep the dynamics of their job intact, right?
00:32:51.899 --> 00:32:58.139
So it's a really important topic for quality of life for a woman going through perimenopause.
00:32:58.139 --> 00:33:03.179
And I would call perimenopause anything from 35 to 55.
00:33:03.419 --> 00:33:04.059
Yeah.
00:33:07.740 --> 00:33:08.059
Yeah.
00:33:08.059 --> 00:33:12.139
A third to a quarter of your life, a quarter to a third of your life for some.
00:33:12.539 --> 00:33:12.939
Yeah.
00:33:12.939 --> 00:33:17.899
That's and this isn't to scare people, it's just to actually to empower them, right?
00:33:17.899 --> 00:33:21.659
Disrupt to empower is how I yeah.
00:33:21.899 --> 00:33:32.379
Cause a little bit of a ripple in the way women's health and medical science treats women because the lived experience is outweighing any data that we can collect.
00:33:32.379 --> 00:33:35.259
But there's no money to invest in women's health.
00:33:35.259 --> 00:33:44.059
And oftentimes pharmaceutical companies don't really benefit from investing in the research unless they have something to gain.
00:33:44.459 --> 00:33:48.859
What is the financial benefit to a pharmaceutical company in this realm?
00:33:48.859 --> 00:33:50.219
There isn't.
00:33:50.219 --> 00:34:00.539
If you're leaning on insurance and medicine to give you quality of life, you've drunk the wrong Kool-Aid.
00:34:00.539 --> 00:34:01.419
Yeah.
00:34:01.419 --> 00:34:03.179
This is not a critique.
00:34:03.179 --> 00:34:04.699
It has a role to play.
00:34:04.699 --> 00:34:11.900
And its job is to fix crucial and critical health crises, right?
00:34:11.900 --> 00:34:22.140
Even your primary care doctor, when they don't they look at you and they look at your labs and you're 35 years old and they're like, You look good, blood pressure's good, weight's good, everything's good, good job, keep going.
00:34:22.140 --> 00:34:24.539
You know, that's not optimizing health.
00:34:24.539 --> 00:34:40.940
That's like just keep doing what you're doing, you know, until your LDLs are a certain number and you try glycerizer through the roof and and you're you're like gaining a little weight, then they're like, you know, let's get you on some medicines, you know, but still not optimizing your health.
00:34:40.940 --> 00:34:51.500
So, you know, if you're the person that has the most skin in the game is also the person who has the most power to change the outcome, which is you, which is you.
00:34:51.740 --> 00:34:52.539
Exactly.
00:34:52.539 --> 00:34:59.660
That's the whole point is that you must take agency and be in control or advocate for your own health.
00:34:59.660 --> 00:35:06.059
But that taking agency and implementing those lifestyle changes basically begins day one.
00:35:06.059 --> 00:35:13.820
Uh, and even those lifestyle choices we make prior to perimenopause, carrying our stress load or just the bad eating habits.
00:35:13.820 --> 00:35:19.099
Like I said, our nutrition might look good on paper, but in fact, it's horrible.
00:35:19.099 --> 00:35:33.660
And that's gonna speak to gut health because we're slowly introducing toxins into the body that eventually it just erodes away at the gut, the leaky gut, it gets those toxins get into the system, and we have that gut-brain barrier.
00:35:33.660 --> 00:35:44.220
So then that's gonna or the gut brain axis, and that ends up impacting brain health and impacts detoxification, hormone regulation, insulin resistance.
00:35:44.300 --> 00:35:48.300
Yes, like your gut influences all of that.
00:35:48.300 --> 00:35:55.660
So, like, you know, the one thing I say in my book, I have two chapters on diet, and the first rule is processed food.
00:35:55.660 --> 00:35:59.099
No, limit, you know, good, better, best.
00:35:59.099 --> 00:36:08.539
Of course, you know, if you're coming from eating McDonald's every night, then me saying don't eat any processed food, you'll be like, and I give up, you know, like, okay, well, it's good, better, best.
00:36:08.539 --> 00:36:14.460
Let's cut out the fast food and start cooking at home, even if that looks like ragu, right?
00:36:14.460 --> 00:36:16.780
It's not the best, but it's good.
00:36:16.780 --> 00:36:18.300
You're not doing McDonald's.
00:36:18.300 --> 00:36:23.260
You know, best looks like you actually, you know, process your own food.
00:36:23.260 --> 00:36:26.539
You get the raw vegetables, you make your own pot pie.
00:36:26.539 --> 00:36:27.740
You know what I mean?
00:36:27.740 --> 00:36:36.300
Like you cook from scratch, and and that does actually play a role because the enzymes in the food influence the enzymes in the gut.
00:36:36.300 --> 00:36:39.420
And that translates to hormone balance.
00:36:39.420 --> 00:36:41.500
It really goes sequentially that way.
00:36:41.500 --> 00:36:46.620
So, gut health and the brain, I mean, that is a well-established phenomenon.
00:36:46.620 --> 00:36:48.860
When your gut is a mess, so is your brain.
00:36:48.860 --> 00:36:53.660
It's the number one place where we start with gut with brain repair in my practice.
00:36:54.059 --> 00:36:54.380
Okay.
00:36:54.380 --> 00:36:55.740
You're very interesting.
00:36:55.740 --> 00:37:01.019
Well, let's talk about your practice and exactly how you are well, your clientele.
00:37:01.019 --> 00:37:05.019
I'm sure menopausal women are very much part of that, your clientele.
00:37:05.019 --> 00:37:18.780
And exactly how you get them onto a lifestyle regime that is going to set them up for success, whether it's just continue on in quality of life, or in the off chance they need to go into surgery.
00:37:18.780 --> 00:37:27.500
And sometimes that surgery is simple, like somebody needs to get a tooth extracted, but are horrified with dentists and want to go general anesthetic.
00:37:27.500 --> 00:37:29.980
And that's my case in point too.
00:37:29.980 --> 00:37:35.900
Luckily, I came out the other end relatively unscathed, but would I have ever thought about the risks?
00:37:35.900 --> 00:37:36.460
No.
00:37:36.700 --> 00:37:58.539
You know, that's an interesting example to give because there are a couple of surgeries that I consider from a functional medicine perspective, like viewing it as a whole person, the microbiome, the level of stress on the cellular level, and how those impact the brain.
00:37:58.539 --> 00:38:04.860
There are a few surgeries that I consider shockingly risky for the brain.
00:38:04.860 --> 00:38:14.860
People, every all the studies show, you know, the obvious, like major surgery, open heart surgery and thoracic surgery, these types of things where we're actually controlling, like we're opening your chest.
00:38:14.860 --> 00:38:16.860
Of course, that's a high risk.
00:38:16.860 --> 00:38:24.059
But the dental, your oral microbiome influences your brain more than you know massively.
00:38:24.059 --> 00:38:25.900
Been hearing this lately.
00:38:25.900 --> 00:38:43.740
So when you have a disruption, you're maybe you have a cavity, maybe there's infection in the jaw, maybe there's some periodontal disease, and they go in and they start cleaning that up and showering the body with those bacteria, the brain takes a hit with that.
00:38:43.740 --> 00:38:45.660
And if it's under general anesthesia, it's double hit.
00:38:45.660 --> 00:38:57.740
Now we've got an infection hit, now we've got the immune disruption, now we got general anesthesia, medical pharmaceutical toxins or environmental stressures, you know, plus just the response.
00:38:57.740 --> 00:39:01.980
That bacterial load coming from the tooth is a big deal to the brain.
00:39:01.980 --> 00:39:07.740
The other one that's in the same because of the same reason is like kidney stones.
00:39:07.740 --> 00:39:12.460
How many old people do you know go in for kidney stones?
00:39:12.460 --> 00:39:16.700
I mean, our cystodase and anesthesia are stacked.
00:39:16.700 --> 00:39:18.700
We get 12 12 cases in a day.
00:39:18.860 --> 00:39:19.980
Bam, bam, bam, bam, bam.
00:39:20.140 --> 00:39:25.180
Because they're stones or prostates or just fast cases, and most of them are stones.
00:39:25.180 --> 00:39:28.140
Well, the bacteria, and I've actually looked at this independently.
00:39:28.140 --> 00:39:38.140
This didn't make it my book because it's too nuanced, but I looked at the bacteria most commonly found and released during stone surgery, like kidney stone surgery.
00:39:38.140 --> 00:39:44.220
And they those bacteria independently cause cognitive dysfunction in the body by themselves.
00:39:44.220 --> 00:39:50.940
So now we're just go lasering them and just releasing them all over the body under general anesthesia.
00:39:50.940 --> 00:39:56.700
That's a actually a pretty significant event, not discussed well because why would we?
00:39:56.700 --> 00:40:00.140
We're not talking about open heart surgery, anesthesia's looking at critical care.
00:40:00.140 --> 00:40:08.620
But from a functional perspective, those two are underrecognized as kind of risky to the brain, surprisingly risky.
00:40:08.620 --> 00:40:12.780
But what was you had a question that I kind of piggybacked off of?
00:40:12.780 --> 00:40:16.780
I can't remember now, because I zeroed in on your oral surgery.
00:40:17.019 --> 00:41:15.480
So when you when your clients come in and you start to work with them, well, first of all, would they come to see you for functional health medicine or pre-surgery preparation, or do you cover sort of the whole gamut?
00:41:16.360 --> 00:41:17.800
Yeah, so I do have a clinic.
00:41:17.800 --> 00:41:25.000
You know, we're trying to build out more systems of like programs and things so that it can access more people can have access faster.
00:41:25.000 --> 00:41:26.520
For me, I'm the bottleneck.
00:41:26.520 --> 00:41:32.840
Like I have a limited schedule and I only see certain people, but I'm a consultant, health consultant is what I call myself.
00:41:32.840 --> 00:41:35.320
So I basically see everything.
00:41:35.320 --> 00:41:48.120
It started with Lyme because my son, I got referred for for complex Lyme, horribly sick Lyme people, often hitting their getting hit hard when they hit perimenopause because now the reserve has gone down.
00:41:48.120 --> 00:41:54.440
So they've been fighting Lyme disease for 20 years and now their reserve is gone and now they can't get out of bed, right?
00:41:54.440 --> 00:41:59.480
And oh surprise, they had Lyme and they've had it for 20 years, you know, that kind of thing.
00:41:59.480 --> 00:42:04.200
But I've I take care of kind of anything that's related to cognitive brain health.
00:42:04.200 --> 00:42:11.640
So I've dealt with a lot of TBI, it's usually neurologic Lyme or even some early cognitive decline in older patients.
00:42:11.640 --> 00:42:18.200
So I have a kind of a big spectrum and then perioperative brain optimization and recovery.
00:42:18.200 --> 00:42:20.200
So I kind of cover all that.
00:42:20.200 --> 00:42:20.840
Okay.
00:42:21.800 --> 00:42:30.520
So it obviously what you were seeing in the operating room in your clinic, this is what was the impetus to your book, Breakthrough Anesthesia Fog.
00:42:30.520 --> 00:42:36.040
And you've shared a lot of the impetus to why you needed to get this information out.
00:42:36.040 --> 00:42:38.920
And you've talked about neurological reserve.
00:42:38.920 --> 00:42:51.400
Let's go back just to explain that to everyday language in the context of can uh perimenopause and menopausal women have any control over their neurological reserve?
00:42:51.720 --> 00:42:52.520
Absolutely.
00:42:52.520 --> 00:42:53.960
That's a great question.
00:42:53.960 --> 00:43:06.200
I think that's the most important question you can ask because it's physiologically what okay, let's let's just talk about what's reserve, an example somebody could take into account.
00:43:06.200 --> 00:43:13.160
How long does it take you to recover from an emotionally draining conversation?
00:43:13.160 --> 00:43:15.560
That's a good question, right?
00:43:15.560 --> 00:43:28.120
So you have a really big kind of emotionally intense conversation with someone, maybe your argument, maybe disagreement, maybe you know, but it's really important to you and it's a really intense conversation.
00:43:28.120 --> 00:43:31.480
How long does it take you to recover from that?
00:43:31.480 --> 00:43:41.960
If you miss a night of sleep, how long does it take you to recover from that feeling of death getting in sleep?
00:43:41.960 --> 00:43:47.000
If you drink alcohol, how long does it take you to recover from that?
00:43:47.000 --> 00:43:48.280
See what I'm saying?
00:43:48.280 --> 00:43:51.160
So these are like everyday stressors that we can encounter.
00:43:51.160 --> 00:43:52.920
Does it knock you off your feet?
00:43:52.920 --> 00:43:55.480
Do you bounce right back and have no problem?
00:43:55.480 --> 00:44:01.480
Like, answer that question, then that gives you kind of a concept of what's my reserve like?
00:44:01.480 --> 00:44:09.240
Does a lot of people, a lot of conversation, like too many people, too much noise, too much conversation, too much stimulation in the environment.
00:44:09.240 --> 00:44:15.800
Does it make you exhausted and have to go like go to your little happy place somewhere else?
00:44:15.800 --> 00:44:17.960
You know, that's also reserve.
00:44:17.960 --> 00:44:23.320
Like, that's how much how much capacity do you have to handle a whole lot of stimulation at one time?
00:44:23.320 --> 00:44:28.200
That is a picture of what neurologic reserve looks like on an everyday level.
00:44:28.200 --> 00:44:30.120
And so, yeah.
00:44:30.120 --> 00:44:41.320
So when we those give you insights into the fact that hi, when I was 20, I could go party at the club until 3 a.m., drink all night with all that noise and all those people.
00:44:41.320 --> 00:44:46.200
And the next day I'm asleep till seven, then I'm up and I'm going to the, I'm gonna go sightseeing.
00:44:46.200 --> 00:44:49.480
Like a 20 year old has a lot of reserve.
00:44:49.480 --> 00:44:52.600
I can't do that at 47 years old.
00:44:52.600 --> 00:44:53.480
Do you know what I mean?
00:44:53.480 --> 00:45:02.120
So there's obvious that's an awesome Obvious evidence of reserve, but reserve determines your ability to handle stressors.
00:45:02.120 --> 00:45:13.960
And if those are small stressors, and I consider anesthesia one of the strongest neurological stressors, then you can have a clue that, okay, I'm struggling with these little things.
00:45:13.960 --> 00:45:24.520
If I go under anesthesia, and it is the neurological stress test, then I could expect that I'm going to need some time for cognitive recovery.
00:45:24.520 --> 00:45:26.840
And how do we build that?
00:45:26.840 --> 00:45:29.720
Well, that has a lot to do with lifestyle diet.
00:45:29.720 --> 00:45:31.720
And again, it goes back to the NSRI.
00:45:31.720 --> 00:45:33.560
Where are you deficient?
00:45:33.560 --> 00:45:37.000
Are you on meds that are wiping out your vitamins?
00:45:37.000 --> 00:45:47.880
Because a lot of them, let's just list a couple, like you know, your antidepressants, they wipe out your B vitamins constantly, along with magnesia, a large percentage of them, and some more specifically.
00:45:47.880 --> 00:45:56.760
If you're on metformin for PCOS or insulin resistance, the first drug they usually give you, B12 is gone.
00:45:56.760 --> 00:45:58.520
CoQ10 is wiped out.
00:45:58.520 --> 00:46:02.760
Those things drive cellular energy and wipe those out long enough.
00:46:02.760 --> 00:46:04.200
You aren't methylating.
00:46:04.200 --> 00:46:10.760
Now we're cycling into a spiral down into poor resilience on a cellular level, DNA level, and on.
00:46:10.760 --> 00:46:11.480
Okay.
00:46:11.480 --> 00:46:13.880
So this is just talking about medications.
00:46:13.880 --> 00:46:14.760
What about your diet?
00:46:14.760 --> 00:46:16.200
Is your gut trashed?
00:46:16.200 --> 00:46:19.240
Are you even absorbing from your food?
00:46:19.240 --> 00:46:22.600
Are you eating foods that actually contain nutrients?
00:46:22.600 --> 00:46:26.760
Your processed foods are often depleted and don't contain what they should.
00:46:26.760 --> 00:46:32.760
Are you getting selenium so that your thyroid can work real well and it's protected through surgery?
00:46:32.760 --> 00:46:33.400
Right?
00:46:33.400 --> 00:46:47.240
Are you these are the questions that we ask and they become more important as we age because we can deal with nutritional deficiency for a while, but eventually it causes cellular dysfunction, which leads to disease.
00:46:47.240 --> 00:46:51.800
So that's where we're at when we hit perimenopause usually.
00:46:52.120 --> 00:46:54.440
Okay, fantastic explanation.
00:46:54.440 --> 00:47:03.320
This is information that needs to be in the hands of all surgeons, all medical clinics, even your GP, uh women.
00:47:03.320 --> 00:47:29.800
Apart from podcasts like this one, and writing your book and having your programs in your clinic, how are you getting this information in front of the change makers or those who are in those positions of power that need to be able to first of all understand it, take it seriously, and then consult wisely with their patients of some of the uh implications or things to think about.
00:47:30.680 --> 00:47:31.640
Great question.
00:47:31.640 --> 00:47:35.800
Uh really to do to be able to do that, research is the key here.
00:47:35.800 --> 00:47:43.800
And and that's one of the it is the mission that drives Beyond Brain Health, which is separate from my practice, a different different business.
00:47:43.800 --> 00:47:46.360
Beyond Brain Health is what's building out everything else.
00:47:46.360 --> 00:47:49.240
My practice is an independent consulting practice.
00:47:49.240 --> 00:48:05.080
But what the mission of Beyond Brain Health is to change the infrastructure to support patients around surgery from all levels and ideally get them into this place where you're going to see the practitioners where the hospitals are engaging with this.
00:48:05.080 --> 00:48:07.480
But to do that, you have to have good research.
00:48:07.480 --> 00:48:10.280
So, what we actually were able to do was amazing.
00:48:10.280 --> 00:48:11.480
It was amazing.
00:48:11.480 --> 00:48:27.800
In March, end of February, for three weeks, I released the NSRI as a research window to kind of test the prototype and build it out and strengthen, catch things, engage the populate, engage the public with did these questions even make sense to you?
00:48:27.800 --> 00:48:29.400
Like, can you answer this really?
00:48:29.400 --> 00:48:30.280
How was that?
00:48:30.280 --> 00:48:35.800
I had like 2200 people fill out the NSRI in three weeks.
00:48:35.800 --> 00:48:36.680
It was amazing.
00:48:36.680 --> 00:48:45.240
And great feedback that I took back and we strengthened the tool and built, we actually added in about 16 more studies.
00:48:45.240 --> 00:48:55.160
From the feedback I got back, I got 60 more studies and backing the tool and strengthened it, captured more things, neuroinflammant inflammation like Lyme.
00:48:55.160 --> 00:48:57.560
I don't know how I missed that one of some with Lyme.
00:48:57.560 --> 00:48:58.680
I didn't ask those questions.
00:48:58.680 --> 00:49:00.280
Like, have you ever had Lyme disease?
00:49:00.280 --> 00:49:01.960
That would be important to you right now.
00:49:01.960 --> 00:49:03.240
But things like that.
00:49:03.240 --> 00:49:07.800
So we built that out and added all those additional studies.
00:49:07.800 --> 00:49:20.280
And right now it's continuing on as a data capture, but we took, we closed out the data aggregate for a study at almost 3,000 people.
00:49:20.280 --> 00:49:22.600
And that we closed it out beginning of July.
00:49:22.600 --> 00:49:24.120
So I took that cohort.
00:49:24.120 --> 00:49:28.920
We're still capturing data, and we're people are still have access to the NSRI and can do them anytime.
00:49:28.920 --> 00:49:38.840
But I took that cohort and basically have written a white paper and I've got some anesthesiologists, neuropsychologists, surgeons even reviewing all that data.
00:49:38.840 --> 00:49:42.440
So we have a proof of concept that's going to be published here very shortly.
00:49:42.440 --> 00:49:43.880
September is the goal.
00:49:43.880 --> 00:49:46.120
So that's our first stage.
00:49:46.120 --> 00:49:52.760
Our second stage is going to be really, it's really exciting because we're going to do prospective research.
00:49:52.760 --> 00:49:59.560
So, and we're putting it into an app that's going to help people be able to guide themselves through preparation and recovery.
00:49:59.560 --> 00:50:02.840
So we get the capture your neurologic resilience to start.
00:50:02.840 --> 00:50:08.680
We kind of give you some feedback on like here's what you can do on how to surgery, prompts and things like that.
00:50:08.680 --> 00:50:10.840
So it's going to be an app designed for that.
00:50:10.840 --> 00:50:17.800
And then post-operatively, to do good research, we need people to fill out an assessment three times, right?
00:50:17.800 --> 00:50:21.160
Like a one week, one month, three months, and six months.
00:50:21.160 --> 00:50:22.280
Okay, four times.
00:50:22.280 --> 00:50:27.960
And that actually gives us real pre and post data that can be published and validated.
00:50:27.960 --> 00:50:36.920
And why that matters is because the institutions that matter when it comes to change making in the practitioner world, they need research.
00:50:36.920 --> 00:50:37.880
We need validation.
00:50:37.880 --> 00:50:44.280
Otherwise, I'm just speculating based on mechanistic things, which is a lot of what we do in longevity medicine, unfortunately.
00:50:44.280 --> 00:50:56.600
We do predictive models, but we don't have any way of like, well, we segmented these people and we post and pre-we don't have a way to do that in longevity, which is, and we trust longevity science, right?
00:50:56.600 --> 00:50:58.680
Like we listen to Dr.
00:50:58.680 --> 00:50:59.880
Huberman, right?
00:50:59.880 --> 00:51:00.120
Ms.
00:51:00.120 --> 00:51:01.400
Andrew Huberman.
00:51:01.400 --> 00:51:02.200
We think he's great.
00:51:02.200 --> 00:51:09.720
I mean, his research is really good, but he doesn't have studies like that to prove longevity narratives that he puts out.
00:51:09.720 --> 00:51:17.480
And so my goal is to rise a little bit above that and be able to really have pre- and post-research.
00:51:17.480 --> 00:51:23.880
Um, and then we can measure if you're really active, you're engaging in this app and where you're doing some of those things.
00:51:23.880 --> 00:51:29.400
We can see how much modifying those things impacts your outcomes, right?
00:51:29.400 --> 00:51:31.960
So that that will change a lot.
00:51:31.960 --> 00:51:35.560
And that's the first level is kind of really getting that research in.
00:51:35.560 --> 00:51:56.120
And then the next the big phase stage-wise, we're giving out, we're creating online group coaching courses so people can have access to the information and have the supplements that they need in the nutrition and the guidance, and even answer some of the questions around hey, is am I is this surgery something I need to pay attention to a little bit more?
00:51:56.120 --> 00:52:03.240
Like the mouth surgery and the bladder, you know, kidney stone surgeries that people don't maybe don't think about.
00:52:03.240 --> 00:52:04.360
Surgery plays a role.
00:52:04.360 --> 00:52:08.200
Like, are you having open heart surgery or you're having a toe bunion surgery?
00:52:08.200 --> 00:52:10.040
Like that's a big difference.
00:52:10.040 --> 00:52:28.520
So, you know, and then the long term is like getting some practitioners certified so they understand the concept and they have a resilience tool to use, they have a way to optimize before the stressful event, and they're ready and they're skilled and they have the knowledge to do it.
00:52:28.520 --> 00:52:30.520
Because right now that's a huge missing gap, right?
00:52:30.520 --> 00:52:34.520
Again, we inadvertently gaslight people because we don't know.
00:52:34.520 --> 00:52:41.800
You know, I I mean, I'm sure early on my career when I was seeing post-operative patients that I did that.
00:52:41.800 --> 00:52:43.000
I'm sure that I did.
00:52:43.000 --> 00:52:46.680
I'm sure that I was like, well, it's just the anesthesia, that'd be fine, yeah.
00:52:46.680 --> 00:52:52.680
You know, just dismissing what was actually a real thing that could have been optimized.
00:52:52.680 --> 00:52:54.520
Of course, I didn't have any formation back then.
00:52:54.520 --> 00:53:00.440
But so the goal is really empowering the patient, empowering the practitioner and changing the system.
00:53:00.440 --> 00:53:03.640
It's a big bold plan, but that's what we're doing.
00:53:04.120 --> 00:53:33.240
Undertaking, huge undertaking, but it starts with one voice at a time, and somebody who's willing to put their hat in the ring and do that research and pursue this to get the answers, largely because it begins with a personal story, like you shared, your mother-in-law, the Lyme's disease with your son, and then just going through our own journey of menopause and saying, This just something's not right here, but I don't have the data to support it, but I've got the lived experience.
00:53:33.240 --> 00:53:38.120
Thank goodness we live in a time where we can have podcasts like this to share that information.
00:53:38.120 --> 00:53:41.640
Think about getting on the Huberman lab and just telling him Andrew.
00:53:41.640 --> 00:53:44.840
Let's talk about your longevity hypothesis.
00:53:44.840 --> 00:53:46.920
Have you actually proven it right or wrong?
00:53:47.160 --> 00:53:47.800
Yeah, right.
00:53:47.800 --> 00:53:56.440
Oh, I want to go against the guy who's like got a gazillion followers, but the reality is like science isn't bad, but it's not validated science, right?
00:53:56.440 --> 00:54:00.760
It's emerging, emerging science not doesn't mean it's wrong.
00:54:00.760 --> 00:54:20.520
Just it's just emerging where you know, when we have something like a stress event that we can measure against, so we know what your resilience is, we have a stress event, we can like really determine do these things that we actually do to our our health and lifestyle strengthen or help or hurt or do nothing, right?
00:54:20.680 --> 00:54:21.160
Yeah.
00:54:21.160 --> 00:54:30.120
What you just said it just made me think of a question I wanted to ask too, and which is one of the draws that brought you to this podcast.
00:54:30.120 --> 00:54:37.240
And it was on my episode about concussion, and I've spoken a couple of times about the nuance between PTSD, concussions, brain health.
00:54:37.240 --> 00:54:39.240
I can spend a long time talking to you about it.
00:54:39.480 --> 00:54:41.320
That trajectory is a huge thing.
00:54:41.640 --> 00:54:47.800
A concussion, a brain injury, again, a stressor, one that cannot be controlled.
00:54:47.800 --> 00:54:51.240
TBIs do not discriminate, it can happen to anybody.
00:54:51.240 --> 00:54:51.800
Right.
00:54:51.800 --> 00:54:59.880
So I'm sure that's on the the questionnaire for the neurological stress recovery index, your NSRI.
00:54:59.880 --> 00:55:02.600
If we have just a little bit of time to address that.
00:55:03.320 --> 00:55:10.040
That's actually one of the groups that is near and dear to my heart because for two reasons.
00:55:10.040 --> 00:55:13.640
One, there are two types of traumatic brain injuries.
00:55:13.640 --> 00:55:18.840
One is a physical traumatic brain injury, a concussion.
00:55:18.840 --> 00:55:25.400
Acquired it's an acquired physical injury, or it's a traumatic physical injury.
00:55:25.400 --> 00:55:28.600
The other is an acquired, which is what you said.
00:55:28.600 --> 00:55:39.880
Acquired injury, which could be from being a meth addict or from repetitive abuse, like verbal, emotional abuse through childhood.
00:55:39.880 --> 00:55:42.280
That can actually change, change the brain.
00:55:42.280 --> 00:55:48.920
More definitively and more well-researched is like the chemical injuries, the chemical brain injuries.
00:55:48.920 --> 00:55:58.520
Those are acquired, they're considered acquired, but they cause similar changes in the brain as a literal concussion, that blackout concussion that is considered TBI.
00:55:58.520 --> 00:56:03.560
So we have a chemical and a traumatic brain injury.
00:56:03.560 --> 00:56:20.280
And anesthesia, kind of in that realm, because of what happens, because under surgery, it's chemical, and then all the immune shifts, all the hormone shifts that occur, not just the drug itself, pose itself, it is itself a chemical stress test, a chemical brain injury.
00:56:20.280 --> 00:56:27.160
It's actually why in the literature we quantify how many times somebody has had anesthesia.
00:56:27.160 --> 00:56:31.800
How many times they have it determines how likely they are to have risk for dementia.
00:56:31.800 --> 00:56:37.000
More and more surgery, higher risk for dementia, because it's like having multiple TBIs.
00:56:37.000 --> 00:56:38.600
So that's number one.
00:56:38.600 --> 00:56:48.280
And number two, to your point, yes, the traumatic brain injuries are actually, we specifically quantify even like, did you get hit from a surprise hit?
00:56:48.280 --> 00:56:49.480
Did you blackout?
00:56:49.480 --> 00:56:55.000
Like how severe we actually measure all that in the NSRI, because it creates sort of a bottleneck.
00:56:55.000 --> 00:57:02.520
If you know, I can't fix a scarred brain, but I can optimize all the domains extra.
00:57:02.520 --> 00:57:11.800
Like, so you've got a traumatic brain injury while your sleep and neural and your sleep, your medication burden, your metabolic health, your social health, your brain and social health.
00:57:11.800 --> 00:57:17.240
We, if we can get those as strong as we can before surgery protecting the brain.
00:57:17.240 --> 00:57:21.880
But why this is so important to me is because I have a dad who was in the military.
00:57:21.880 --> 00:57:23.800
He was a special forces guy.
00:57:23.800 --> 00:57:32.760
And in the military, there's two groups that really get double hits here: the military and contact sports, professional sports.
00:57:32.760 --> 00:57:39.720
Both of those populations, one have higher TBIs, and two have higher surgeries.
00:57:39.720 --> 00:57:47.960
Both get injured more often with their brain and both have to undergo surgery more because of the nature of their profession.
00:57:47.960 --> 00:57:52.920
You know, the athletes over here are getting tackled and he's ripping his ACL and he has to have surgery.
00:57:52.920 --> 00:57:57.080
And again, another surgery for realizing a meniscus, and then another surgery for a shoulder.
00:57:57.080 --> 00:57:59.880
And meanwhile, he's getting hit after hit after hit.
00:57:59.880 --> 00:58:01.960
Same thing with the military guy.
00:58:01.960 --> 00:58:03.880
They get blast concussions a lot.
00:58:03.880 --> 00:58:09.400
Maybe they don't get thrown off the, you know, the airplane or whatever.
00:58:09.400 --> 00:58:16.600
Maybe they don't get a major physical fall, but they get blast concussions, which are known to cause a similar type of injury.
00:58:16.600 --> 00:58:22.920
And then they have to have surgery because of the nature of their jet and wear and tear and all the things that soldiers go through.
00:58:22.920 --> 00:58:25.000
They end up having more surgery than most as well.
00:58:25.000 --> 00:58:29.240
So those two are actually in a very unique category of high risk.
00:58:29.240 --> 00:58:35.720
And why I really want this to be something that is implemented across those areas.
00:58:35.720 --> 00:58:40.680
Specifically, I know this is fall into the menopause, but they women are in the military too.
00:58:40.680 --> 00:58:42.920
You know, women's sports is a big deal too.
00:58:42.920 --> 00:58:46.520
So now you got a pair of menopause or woman playing soccer, you know.
00:58:46.520 --> 00:58:47.560
Oh my gosh.
00:58:47.720 --> 00:58:50.200
So special ops woman in her 40s.
00:58:50.200 --> 00:58:51.080
They happen, yeah.
00:58:51.080 --> 00:58:54.760
But she's still going into on the front line.
00:58:55.080 --> 00:58:55.720
Correct.
00:58:55.720 --> 00:59:15.000
So, yeah, so this is certain certainly is its own category of high risk and one that deserves more research, which is why I look forward to the data that I can capture as people come through and do the full, you know, app and pre and post, and I can stratify it on these types of categories.
00:59:15.000 --> 00:59:17.240
Like, are you a person who's getting injured?
00:59:17.240 --> 00:59:18.920
Do you have a lot of traumatic brain injury?
00:59:18.920 --> 00:59:19.960
Like, what kind of sports do you?
00:59:19.960 --> 00:59:24.760
I can kind of do some moral research on that and fill in some of the research gaps there.
00:59:24.760 --> 00:59:28.360
And maybe there are special things we need to do to strengthen that.
00:59:28.360 --> 00:59:31.880
Right now, we're focused on overall neurologic resilience of neurologic.
00:59:31.880 --> 00:59:41.560
But maybe they need more, I don't know, something else, more hydration, more electrolytes, more minerals, more, you know, those types of things.
00:59:41.560 --> 00:59:43.720
Ketones, ketones.
00:59:44.040 --> 00:59:44.600
Yeah.
00:59:44.600 --> 00:59:45.240
Wow.
00:59:45.240 --> 00:59:53.640
We could talk about things, factors that we can do to improve brain health in so many ways from our nutrition to supplements to exercise, resilience training.
00:59:53.640 --> 00:59:54.920
I'm gonna bring you back.
00:59:54.920 --> 01:00:07.160
I because when you crack that nut open with the concussions and brain injuries and go down that rabbit hole in the in the research, I would love, love, love to learn more and share that on this podcast.
01:00:07.160 --> 01:00:08.280
For sure.
01:00:08.280 --> 01:00:11.240
We've taken in a lot, a lot of science.
01:00:11.240 --> 01:00:24.840
I love science, especially when it comes to the brain, because the fact that I have had three concussions when I was a child, and oral surgery when I was well about five years ago.
01:00:24.840 --> 01:00:27.960
So I'm really getting a little bit worried for my brain health.
01:00:28.200 --> 01:00:28.520
Yeah.
01:00:28.520 --> 01:00:30.280
Well, the goal isn't worry.
01:00:30.280 --> 01:00:37.320
I think if you're doing those podcasts, you're already kind of doing more optimization than the average person because you have a little bit more knowledge.
01:00:37.320 --> 01:00:44.760
I mean, you're interviewing probably the experts here in a lot of fields, so I'm sure you're I'm sure you're doing a lot of the right things.
01:00:44.920 --> 01:00:52.360
So yes, and you know, it is mentally stimulating to sit down with the experts in the field and then take in what they share.
01:00:52.360 --> 01:01:06.200
And I feel my purpose, because I have science communication for so many years, is just to take in all of that from the experts and deliver it to the public and allow them to listen to it and see if it applies and exercise some discernment.
01:01:06.200 --> 01:01:10.760
But most importantly, we've said this a few times, is that empowerment piece.
01:01:10.760 --> 01:01:14.440
Don't wait for the research to back up your lived experience.
01:01:14.440 --> 01:01:25.560
Go forth and start advocating and taking those lifestyle changes that put you back in a driver's seat and giving you that level of control so that you can have quality of life.
01:01:25.560 --> 01:01:26.840
And what is quality of life?
01:01:27.320 --> 01:01:28.440
Whatever that looks like for you.
01:01:28.440 --> 01:01:28.760
Yeah.
01:01:28.760 --> 01:01:29.640
For you, yeah.
01:01:29.640 --> 01:01:33.400
You know, you I'm not going to spend too long, but you made a really great point.
01:01:33.400 --> 01:01:37.320
And it's actually a good thing to leave people with something actionable.
01:01:37.320 --> 01:01:47.560
And one of the things that you just said was that you're really, it's like really stimulating, neurologically stimulating for you to interview all these people and learn new information.
01:01:47.560 --> 01:01:53.560
It's actually a studied piece of the NSRI, it's in the in the domain of brain and social health.
01:01:53.560 --> 01:01:57.000
We ask, do you speak more than one language?
01:01:57.000 --> 01:01:58.920
Do you play an instrument?
01:01:58.920 --> 01:02:02.360
These things actually have an impact on neuroresilience.
01:02:02.360 --> 01:02:17.240
And I kind of make a joke in chapter three or four, I leave people with like a word search because really reading my book is challenging to people to challenge their paradigm, challenge their thinking, and it's learning something new.
01:02:17.240 --> 01:02:20.840
And learning something new builds new neurons.
01:02:20.840 --> 01:02:21.720
It really does.
01:02:21.720 --> 01:02:24.760
Doing something hard builds new neurons.
01:02:24.760 --> 01:02:27.800
It's a known fact function of neuroplasticity.
01:02:27.800 --> 01:02:39.240
So, you know, taking the effort to learn about your health at a deeper level is not only good to advocate for yourself, but it's actually neuroprotective.
01:02:39.240 --> 01:02:45.560
You're doing something hard, you're learning something new, you're building neuroplasticity in the process of doing that learning.
01:02:45.560 --> 01:02:47.320
So do that today.
01:02:47.320 --> 01:02:49.000
Like read read a new book.
01:02:49.000 --> 01:02:51.560
Don't scroll on Instagram in the evening.
01:02:51.560 --> 01:02:58.600
Do something that challenges you, whether it's read an article or you know, challenge your paradigm or learn how to play chess.
01:02:58.600 --> 01:02:59.240
You know.
01:03:01.000 --> 01:03:03.320
Well, you've ended it on a great note about your book.
01:03:03.320 --> 01:03:05.720
Go out and read Sandra's book, Dr.
01:03:05.720 --> 01:03:07.480
Bergeron's book.
01:03:07.480 --> 01:03:13.160
So let our listeners know where they can find your book and where they can find where you work.
01:03:13.160 --> 01:03:14.360
All of the above.
01:03:14.920 --> 01:03:18.760
Yeah, so uh I'm at Beyond Brain Health on almost all platforms.
01:03:18.760 --> 01:03:21.560
I'm pretty sure it's even on Substack at Beyond Brain Health.
01:03:21.560 --> 01:03:27.880
So if you look at look at at Beyond Brain Health, you'll find me on YouTube, Instagram, Facebook, Substack, LinkedIn.
01:03:27.880 --> 01:03:29.880
I'm Sandra Bargeron.
01:03:29.880 --> 01:03:31.640
And my website's Beyond Brain Health.
01:03:31.640 --> 01:03:32.680
So it's super simple.
01:03:32.680 --> 01:03:34.520
Everything's Beyond Brain Health.
01:03:34.520 --> 01:03:36.840
And you can find a lot of research there.
01:03:36.840 --> 01:03:42.680
We do a weekly, you know, neuror resilience trust tip in our newsletter.
01:03:42.680 --> 01:03:49.240
So you can get plugged into that and get some actual action steps to strengthen your neurologic resilience and do that.
01:03:49.240 --> 01:03:50.920
But it's not a spammy email.
01:03:50.920 --> 01:03:53.080
It's really here's one thing you can do.
01:03:53.080 --> 01:03:55.480
You know, go forth and strengthen your brain, you know.
01:03:55.480 --> 01:03:58.520
But that that's where you can find me.
01:03:58.520 --> 01:04:00.200
And the book is on Amazon.
01:04:00.200 --> 01:04:09.160
I did self-publish, so you can find me at Beyond Brain Health, uh, or actually uh Breakthrough Anesthesia Fog is the name of the book.
01:04:09.160 --> 01:04:14.360
It will be available on audio uh books here in the next few weeks.
01:04:14.360 --> 01:04:19.000
I've been keep hearing it's gonna be next week, next week, but I'm pretty sure it's coming in the next two weeks.
01:04:19.000 --> 01:04:23.080
So I can Kindle, print, and audiobook.
01:04:23.080 --> 01:04:24.040
Oh my goodness.
01:04:24.040 --> 01:04:25.640
Are you the narrator of the book?
01:04:25.640 --> 01:04:29.080
I'm not, but I found somebody who sounds pretty close to me.
01:04:29.080 --> 01:04:30.280
So wonderful.
01:04:30.280 --> 01:04:33.880
Yeah, it was the bottleneck of time to get it done.
01:04:33.960 --> 01:04:36.200
So I hired a voice actor.
01:04:36.200 --> 01:04:37.480
That is so impressive.
01:04:37.480 --> 01:04:38.280
Oh my goodness.
01:04:38.280 --> 01:04:40.760
Well, we'll get all those links in the show notes below.
01:04:40.760 --> 01:04:49.000
And also, I'm gonna have to pick your brain about self-publishing because I've got so many book ideas started, almost finished on the go.
01:04:49.000 --> 01:04:53.880
And then it comes to that sharing to the public, and that that's what I find daunting.
01:04:53.880 --> 01:04:55.640
Oh, it is daunting.
01:04:55.640 --> 01:05:07.560
So thank you so much for sharing your expertise, your knowledge, your passion, and coming onto the show and just giving it another lens to which we should look at our health.
01:05:07.560 --> 01:05:18.040
And the brain health being one thing, but just what happens to the brain when additional stressors are loading it, and then we have to go into a surgery of some of some sort.
01:05:18.040 --> 01:05:18.680
Yeah.
01:05:18.680 --> 01:05:23.080
What I learned is just forgive the pun, but it's intended, it blows my mind away.
01:05:23.080 --> 01:05:23.640
It really does.
01:05:23.640 --> 01:05:27.240
So I'm so yeah, so thank you.
01:05:27.720 --> 01:05:28.280
Awesome.
01:05:28.280 --> 01:05:29.400
Well, thanks for having me.
01:05:29.400 --> 01:05:30.520
I enjoyed the time.